Federer to start against Lajovic, Williams v Rus
Federer to start against Lajovic, Williams v Rus.
Defending champion Roger Federer will begin his quest for a record-extending ninth Wimbledon title with a first round clash against Serbian world number 57 Dusan Lajovic.
The 36-year-old Swiss, seeded one, has been placed in the same half of the draw as in-form Croatian third seed Marin Cilic who he beat in last year's final.
Seven-time women's champion Serena Williams was handed a comfortable-looking first-round draw after being paired with 107th ranked Dutchwoman Arantxa Rus.
The 36-year-old, who has played only a handful of matches this year after giving birth last September, is seeded 25th after being bumped up from a current world ranking of 183.
Defending women's champion Garbine Muguruza of Spain will play Briton Naomi Broady in the first round.
Men's second seed Rafael Nadal, champion in 2008 and 2010, starts against Israel's Dudi Sela while three-time champion Novak Djokovic faces American Tennys Sandgren.
British favourite Andy Murray, still a doubt for the tournament as he makes a comeback from nearly a year out with a hip injury, is unseeded and was drawn to play Benoit Paire.
The biggest match of the men's first round will see sixth seed Grigor Dimitrov face three-time Grand Slam champion Stan Wawrinka who like Murray is unseeded after an injury break.
Women's top seed Simona Halep will play Japan's Kurumi Nara in the first round.
For more infomation >> Federer to start against Lajovic, Williams v Rus - Duration: 2:21.-------------------------------------------
2018 vs. 2078 - 60 Years Later!!! So Funny! (CC Available) - Duration: 9:16.
Fanta
So refreshing!
Omg, this thing is so heavy!
My back hurts now!
Hubba Bubba!
Big Mama has a great idea!
huh?
I heard something!
Who is it in there?
Hubba Bubba!
I wonder how am I gonna be like 60 years from now?
60 years later...
Banh Bao!
Banh Bao
Banh Bao
Where are you?
Banh Bao
What is it Leo?
I need to take my afternoon nap!
What do you want now?
Change the channel
I think I left the TV remote upstairs
Wait a minute!
I'll go get it
Goodness, Leo is getting more and more handsome as he ages!
Leo is getting stronger and stronger as year goes by
Leo, be careful!
or you're gonna break your hip
Hello guys,
Banh Bao
Leo
Hi mom
Guys, remember what I told you 60 years ago..
You didn't listen to me
Eat healthy, lots of vegetables!
fruits,
You guys had a really poor diet!
I told you to stay away from sugar
60 years ago Big Mama warned you
Salad? Not again mom!
Mom, I can't eat it no more!
Come give Big Mama a hug honey!
Bye mom!
See you tonight
I love you
Have you guys seen anyone over a 100 years old and still look like this?
I need to go get that TV remote mom!
I have to climb all the way up there
Honey, you need my help?
Be careful!
Don't worry mom!
I can handle this!
Big Mama needs to go upstairs too!
Go after me mom
Put me down mom, I can go myself
Thanks mom!
You're welcome honey!
Bye
I just realized! I need to listen to Big Mama
Guys, remember don't eat too much sugar
Eat healthy
Stay fit! exercise daily
Eat plenty of fruits, vegetables, drink lots of water
If you like this video, don't forget to give it a thumb up
Click that subscribe button
and turn on that notification bell
Bye guys, I will see you guys on Princess Banh Bao tomorrow
Bye guys, love you:)
Banh Bao, I just had a weirdest nightmare
you and I we're like super old
and Big Mama she is still like super strong
-------------------------------------------
NYT: Rod Rosenstein Felt Used By President Donald Trump After Comey Firing | The 11th Hour | MSNBC - Duration: 11:25.
For more infomation >> NYT: Rod Rosenstein Felt Used By President Donald Trump After Comey Firing | The 11th Hour | MSNBC - Duration: 11:25. -------------------------------------------
Who's On President Donald Trump's Supreme Court Short List? | The 11th Hour | MSNBC - Duration: 7:45.
For more infomation >> Who's On President Donald Trump's Supreme Court Short List? | The 11th Hour | MSNBC - Duration: 7:45. -------------------------------------------
How The FBI Got Tipped Off To Paul Manafort's Evidence | Rachel Maddow | MSNBC - Duration: 25:40.
For more infomation >> How The FBI Got Tipped Off To Paul Manafort's Evidence | Rachel Maddow | MSNBC - Duration: 25:40. -------------------------------------------
Arsenal transfer news BBC Sport man reveals one player who is signing new deal ● News Now ● #AFC - Duration: 2:01.
Arsenal will tie down defender Calum Chambers to a new four-year deal, according to BBC
Sport's David Ornstein.
The former Southampton star found regular gametime hard to come by under Arsene Wenger
after his St. Mary's exit.
Chambers was loaned out to Middlesbrough back in 2016 but returned to the Emirates last
term to play a bit-part role in Arsenal's poor domestic season.
However, according to Ornstein, new boss Unai Emery sees the 23-year-old as a key part of
his long-term plans.
"Calum Chambers will today sign a new 4yr contract with Arsenal to keep him there until
2022," he tweeted.
"Only signed 2yr extension in Oct 2017 that tied him down until 2021 but new head coach
Unai Emery sees huge potential in 23yo + wants him to compete for starting berth at centre-back."
Chambers arrived in north London from Southampton for £16m back in 2014.
The versatile defender only made 48 appearances for the club under Wenger.
Arsenal have already added a new defender to their ranks in the form of Juventus defender
Stephan Lichtsteiner.
The Swiss star has joined on a free transfer after seven years with the Italian giants.
Meanwhile, the Gunners are close to announcing a deal for Borussia Dortmund star Sokratis
Papastathopoulos.
The Greek international will join Arsenal next week.
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FNN: Deaf Puppy Rescue in Alabama; Vigils for Annapolis newspaper victims - Duration: 11:29:11.
For more infomation >> FNN: Deaf Puppy Rescue in Alabama; Vigils for Annapolis newspaper victims - Duration: 11:29:11. -------------------------------------------
Why Did Campus Custodian Fatally Attack Parking Officer? - Duration: 1:52.
For more infomation >> Why Did Campus Custodian Fatally Attack Parking Officer? - Duration: 1:52. -------------------------------------------
Открытые концовки фильмов, которые проигнорировали в продолжении - Duration: 5:37.
For more infomation >> Открытые концовки фильмов, которые проигнорировали в продолжении - Duration: 5:37. -------------------------------------------
【劉鎮東】東風破 之 首相署的深夜恐嚇 - Duration: 5:12.
For more infomation >> 【劉鎮東】東風破 之 首相署的深夜恐嚇 - Duration: 5:12. -------------------------------------------
Millones de dólares habrían sido desviados de un programa social del gobierno mexicano - Duration: 2:39.
For more infomation >> Millones de dólares habrían sido desviados de un programa social del gobierno mexicano - Duration: 2:39. -------------------------------------------
Warface: Облажался, но собрался… Remington MSR - Duration: 10:01.
For more infomation >> Warface: Облажался, но собрался… Remington MSR - Duration: 10:01. -------------------------------------------
Top 5 Bài Nhạc Nhảy Shuffle Dance/Cutting Shape Hay Nhất #4 (Songs For Shuffle) - Duration: 2:55.
For more infomation >> Top 5 Bài Nhạc Nhảy Shuffle Dance/Cutting Shape Hay Nhất #4 (Songs For Shuffle) - Duration: 2:55. -------------------------------------------
Thử Thách Ăn Hết 5 Quả Chuối Xanh Nhận Tiền Thưởng - Sung Vlogs - Duration: 11:09.
For more infomation >> Thử Thách Ăn Hết 5 Quả Chuối Xanh Nhận Tiền Thưởng - Sung Vlogs - Duration: 11:09. -------------------------------------------
Electric car insurance how to get the best price for your Leaf or Zoe 🔌🔋🚗 - Duration: 6:14.
welcome to this week's vlog on this week's vlog we're going to be discussing
electric car insurance do you need special insurance for electric car how
do you get the cheapest price
{MUSIC}
so if you like saving money like me and you're a
little bit tight and you try and get the best deal as you possibly can which
probably most of you are if you drive an electric car even if you just drive it
for ECO reasons like me you also like saving money it's a win situation with
electric cars it's a double win for me and car insurance is one of the big
grips we're trying to get a good deal these days in the electric car sometimes
it can be quite difficult with certain insurance companies excluding electric
vehicles and other ones not including battery lease systems and not
understanding the battery lease it was time for me to this year do a little bit
more of an in-depth video on how to get the best deal on your electric car
insurance now I did the normal website comparison stuff as always so I did my
moneySuperMarket check for the best price I possibly could put my reg details
in and it fired out a price now non-protected no claims don't forget
there's two drivers on here Laura's the main driver of the car so
the insurance is in Laura's name i drive vehicles under the trade
insurance but I have to be covered personally for Laura's car there's two
drivers on the policy Laura's a young driver she only got five years driving
experience in five years no claims the price did was £429
as you can see there the price for a non-protected policy
protecting your no claims dropped to £408 there's a little
bit of an excess there with more> than which isn't great now i also had a
renewal quote from quote me happy which was £350 but a
much higher voluntary access on that policy these are high prices in my mind
for an electric car driver electric car drivers we tend to be slower drivers we
drive more economically and we don't tend to have any boy racers by driving
Electric cars yet because they don't make the RS Zoe
but that's another discussion altogether but that we'd drive better so surely
there's a company out there that would provide insurance for us so spent some
time looking for brokers that specialize with schemes for electric cars tried
tried one broker their price was a little bit high it was six seven hundred
pound but I'm not going to mention who it was but it was they were dear
they were dearer than all the other things it was a specialist insurance for
EV cars so you know I was moving on to at least someone who understood
electric cars but I was surprised why it was so much did some more digging around
and came across a company called pluginsure
so I thought yeah they've even got a name for doing electric car insurance
great the other company was just a normal running name not like I said not
going to mention them but pluginsure proper name for electric cars actually
seem to be actively trying to get electric car customers their quote was
well quite a bit cheaper they came back at £296 headers like - yeah £296.37
protected protected now like I said Laura Laura only been
driving five years she's a much younger model than me I was a lucky bugger
um but yeah Laura's much younger than me so she's not got was driving
expensive to get price under £300 with a young driver on on the policy
it's fantastic now I put a link to them down in the description below and I've also
put a number they have an online quote system which is pretty much the
price I've got there is the price it gave me on the online system they also
rang them because it's called a quick quote quick quote so I wasn't sure if it
was just an estimate quote but I thought it would be wrong it under £300
seems too cheap so I rang them spoke to me said no that is the price
they ran a full quote with me and that's the price i got it's a small small firm
there's not a lot there's not a lot of employees definitely put onto the phone
pretty quickly seem very efficient they seems to be running for quite some time
I did some more digging to some other people I know who've got it I've had leaf
owners and i3 owners run some comparison tests and they all said it's
cheaper than what they were getting off off of a insurance company so if you've
got a Nissan Leaf or a Renault Zoe or a BMW i3 or any other electric car give
them a call try and get a quote obviously hybrids and stuff like that
give them a quote see what they come back with and let me know what let me
know in the comments below were they cheaper than you current
insurers have you gone with them have you heard of them before have you used
them before are you already a customer of them a bit and just let us know in
the comments below I'm really really interested even if you'd not with them
you've got other insurance quotes let me know what you're paying around the
market but pluginsure seem to be the cheapest they seem to specialise
electric cars they are a proper FCA regulated company they're using a major
underwriter for the insurance and it's a scheme set off electric car drivers so
thumbs up for me from them they seem to do a really really good job of getting
really good prices let me know let me know in the comments below thanks so
much for watching this week's video don't forget to give it a thumbs up
don't forget to share it subscribe to my channel if you haven't already and also
check out my other videos down there if you're not a patreon supporter consider
supporting me on patreon from as little as a £1 a month it really really does help
helps me buy a new equipment etc and make the channel a little bit better thank you
very much for watching and I'll see you again next week goodbye
-------------------------------------------
最新【希盟新政府上任2個月】民調展示出希盟的表現 - Duration: 12:53.
For more infomation >> 最新【希盟新政府上任2個月】民調展示出希盟的表現 - Duration: 12:53. -------------------------------------------
【视频】好消息！甲州政府为华社带来佳音，宣布承认统考！ - Duration: 13:52.
For more infomation >> 【视频】好消息！甲州政府为华社带来佳音，宣布承认统考！ - Duration: 13:52. -------------------------------------------
巫伊合作 重燃希望？ 最新民調指路，輪到希盟怕怕了…… - Duration: 22:00.
For more infomation >> 巫伊合作 重燃希望？ 最新民調指路，輪到希盟怕怕了…… - Duration: 22:00. -------------------------------------------
Guru Pournami 2018 | Pournami 2018 | Pournami Chandra Grahan 2018 | Guru Pournami | KALABHAIRAVA - Duration: 6:42.
Please Like Comments
-------------------------------------------
Видео для детей с игрушками. Про спорт! Мультфильмы - Duration: 4:19.
For more infomation >> Видео для детей с игрушками. Про спорт! Мультфильмы - Duration: 4:19. -------------------------------------------
B - Duration: 0:07.
For more infomation >> B - Duration: 0:07. -------------------------------------------
2018 vs. 2078 - 60 Years Later!!! So Funny! (CC Available) - Duration: 9:16.Fanta
So refreshing!
Omg, this thing is so heavy!
My back hurts now!
Hubba Bubba!
Big Mama has a great idea!
huh?
I heard something!
Who is it in there?
Hubba Bubba!
I wonder how am I gonna be like 60 years from now?
60 years later...
Banh Bao!
Banh Bao
Banh Bao
Where are you?
Banh Bao
What is it Leo?
I need to take my afternoon nap!
What do you want now?
Change the channel
I think I left the TV remote upstairs
Wait a minute!
I'll go get it
Goodness, Leo is getting more and more handsome as he ages!
Leo is getting stronger and stronger as year goes by
Leo, be careful!
or you're gonna break your hip
Hello guys,
Banh Bao
Leo
Hi mom
Guys, remember what I told you 60 years ago..
You didn't listen to me
Eat healthy, lots of vegetables!
fruits,
You guys had a really poor diet!
I told you to stay away from sugar
60 years ago Big Mama warned you
Salad? Not again mom!
Mom, I can't eat it no more!
Come give Big Mama a hug honey!
Bye mom!
See you tonight
I love you
Have you guys seen anyone over a 100 years old and still look like this?
I need to go get that TV remote mom!
I have to climb all the way up there
Honey, you need my help?
Be careful!
Don't worry mom!
I can handle this!
Big Mama needs to go upstairs too!
Go after me mom
Put me down mom, I can go myself
Thanks mom!
You're welcome honey!
Bye
I just realized! I need to listen to Big Mama
Guys, remember don't eat too much sugar
Eat healthy
Stay fit! exercise daily
Eat plenty of fruits, vegetables, drink lots of water
If you like this video, don't forget to give it a thumb up
Click that subscribe button
and turn on that notification bell
Bye guys, I will see you guys on Princess Banh Bao tomorrow
Bye guys, love you:)
Banh Bao, I just had a weirdest nightmare
you and I we're like super old
and Big Mama she is still like super strong
-------------------------------------------
总决赛巴西女排零封荷兰，中国巴西携手进4强 - Duration: 2:45.
For more infomation >> 总决赛巴西女排零封荷兰，中国巴西携手进4强 - Duration: 2:45. -------------------------------------------
好男人梅西和安东内拉青梅竹马，是现实世界中的童话爱情故事 - Duration: 4:00.
For more infomation >> 好男人梅西和安东内拉青梅竹马，是现实世界中的童话爱情故事 - Duration: 4:00. -------------------------------------------
赵丽颖合作过的85后男明星，谁更般配呢？ - Duration: 3:53.
For more infomation >> 赵丽颖合作过的85后男明星，谁更般配呢？ - Duration: 3:53. -------------------------------------------
阿根廷迎来重大利好消息，2大克星被淘汰梅西或将在俄罗斯称王 - Duration: 4:03.
For more infomation >> 阿根廷迎来重大利好消息，2大克星被淘汰梅西或将在俄罗斯称王 - Duration: 4:03. -------------------------------------------
Sorry To Bother You - "Mark It Down Now: No Other Movie In 2018 Will Come Close To This One" - /Film
For more infomation >> Sorry To Bother You - "Mark It Down Now: No Other Movie In 2018 Will Come Close To This One" - /Film-------------------------------------------
For more infomation >> Sorry To Bother You - "Mark It Down Now: No Other Movie In 2018 Will Come Close To This One" - /Film-------------------------------------------
Après avoir regardé ceci, Vous n'abandonnerez jamais la pelures d'oignon - Duration: 6:20.
For more infomation >> Après avoir regardé ceci, Vous n'abandonnerez jamais la pelures d'oignon - Duration: 6:20. -------------------------------------------
For more infomation >> Après avoir regardé ceci, Vous n'abandonnerez jamais la pelures d'oignon - Duration: 6:20.-------------------------------------------
Creating An Interlinking Chain Using The Divide And Weld Functions In Canvas Workspace - Duration: 9:31.
For more infomation >> Creating An Interlinking Chain Using The Divide And Weld Functions In Canvas Workspace - Duration: 9:31. -------------------------------------------
For more infomation >> Creating An Interlinking Chain Using The Divide And Weld Functions In Canvas Workspace - Duration: 9:31.-------------------------------------------
Mario Party 10: "Gamer Gaming" All mini games in Mario Party - Duration: 13:42.
Mario Party 10: "Gamer Gaming" All mini games in Mario Party
-------------------------------------------
For more infomation >> Mario Party 10: "Gamer Gaming" All mini games in Mario Party - Duration: 13:42.-------------------------------------------
Happy Wedding Theatrical Trailer | Sumanth Ashwin | Niharika | #HappyWeddingTrailer | UV Creations - Duration: 1:35.
For more infomation >> Happy Wedding Theatrical Trailer | Sumanth Ashwin | Niharika | #HappyWeddingTrailer | UV Creations - Duration: 1:35. -------------------------------------------
Haven't played Splatoon 2 in a while. - Duration: 53:37.
For more infomation >> Haven't played Splatoon 2 in a while. - Duration: 53:37. -------------------------------------------
Miraculous ladybug Season 2 Identity Revealed (FANMADE SCENE) - Duration: 2:08.
Pound it!...
Wait!.. Where are you going?!
Please...i won't tell anyone who you are...
I can't..
I'm sorry... its not exactly easy for me either... trust me...
phew... That was a close shade...
Oh well.. tikki, i'm really messed up this time...
Marinette: I didn't mean to hurt him/ Cat noir: What?! this can't be!..
You just over reacted a little... just let it go... tomorrow will be a new day..
Marinette..
What are you doing here? Don't you have like... superhero things to do?....
I swear to myself that i tell you as soon as i saw you...
Claws in..
I'm glad that girl beneath the mask is you marinette...
We a team aren't we?
-------------------------------------------
[브랜드 히스토리] 모터스포츠에 '잔뼈' 굵은..미니 JCW의 62년 역사는? - Duration: 11:34.
For more infomation >> [브랜드 히스토리] 모터스포츠에 '잔뼈' 굵은..미니 JCW의 62년 역사는? - Duration: 11:34. -------------------------------------------
ប៊ុត សីហា បទថ្មី ចិត្តខ្លែង ពិរោះមែន | Buth Seyha New Song Collection | Buth Seyha New Song Non Stop - Duration: 51:35.
But Seyha New Song Collection | But Seyha New Song Non Stop
But Seyha New Song Collection | But Seyha New Song Non Stop
But Seyha New Song Collection | But Seyha New Song Non Stop
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Learn wild animals names for kids | nursery rhymes,children,toddlers,dinosaur,NASH TOON Tv - Duration: 4:46.
learn wild animals names for kids
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럭셔리 SUV 시장 가파른 성장..아우디도 'Q9'으로 도전장 - Duration: 2:56.
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애스턴 마틴, 'DBS 슈퍼레제라' 국내 투입 계획..가격은 3억원대 - Duration: 4:32.
For more infomation >> 애스턴 마틴, 'DBS 슈퍼레제라' 국내 투입 계획..가격은 3억원대 - Duration: 4:32. -------------------------------------------
C - Duration: 0:07.
For more infomation >> C - Duration: 0:07. -------------------------------------------
B - Duration: 0:07. For more infomation >> B - Duration: 0:07. -------------------------------------------
A - Duration: 0:07.
For more infomation >> A - Duration: 0:07. -------------------------------------------
D - Duration: 0:07.
For more infomation >> D - Duration: 0:07. -------------------------------------------
Bali's Mt Agung volcano erupts again, closing Denpasar Airport and leaving flights cancelled - Duration: 8:17.
Bali's Mt Agung volcano erupts again, closing Denpasar Airport and leaving flights cancelled
Hundreds of flights to and from the Indonesian holiday island of Bali have been grounded or delayed on the eve of the school holidays as clouds of volcanic ash spew more than two kilometres into the air from the Mt Agung volcano.
The National Disaster Mitigation agency said nearly 450 flights had been cancelled to the island, with about 75,000 passengers affected worldwide.
Airlines are updating their advice and are expected to cancel more flights throughout the day after Denpasar's Ngurah Rai International Airport was closed at 3:00am local time (5:00am AEST) today.
It is not due to reopen until at least 7:00pm local time.
In a tweet, the airport advised people to "stay updated for every information from our official account".
Airlines are waiting to see whether the airport will reopen later tonight.
If that happens, Melbourne Airport spokesman Grant Smith said later flights may be able to go ahead.
"Based on the flight time out of Melbourne, it's possible some flights may still depart today, but we'll have to take our guidance from the airlines once they're notified what's happening on the ground there," he said.
School holidays start for Victoria and Western Australia tomorrow.
Wedding plans thrown into disarray.
Bride-to-be Kartina Curtis is due to be married on a beach in Bali on Wednesday.
Ms Curtis and her groom arrived at Perth Airport this morning with their six-person bridal party, only to find their AirAsia flight had been cancelled.
She said they were still hoping to secure a flight this evening.
"I'm slightly nervous, trying to be optimistic but we haven't had a lot of good news coming from the counter," she said.
"We don't have a plan B, unless they want to have a wedding on the tarmac for us, I'm not sure what we're going to do.
Second-time unlucky for Bali tourist.
Virgin Australia has told the ABC it has cancelled all flights to Denpasar today, as has AirAsia.
Jetstar cancelled several flights overnight and is expected to cancel more this morning.
One Jetstar flight bound for Denpasar from Perth overnight was forced to land in Port Hedland to re-fuel before returning to Perth.
Donna Barwood and her family arrived at Perth airport his morning and told ABC Radio Perth their school holiday plans had been dashed for the second time in months.
"We were due to fly out the beginning of December last year and all flights were cancelled then, and it was the same volcano — it does not like us," she said.
"We're looking at other flights, but unfortunately Jetstar left it so late that all the other flights are now booked.
Friday morning was Perth's coldest for the year and the Hunt family, like many others, was looking to escape to Bali's warmer climate.
Laura Hunt, 12, said she would rather be in Indonesia, but was still happy to be on holidays.
"It was a little annoying because we would rather be in warmth, but it's not too bad," she said.
Her mother Erica said they were luckily able re-schedule their flight to Monday.
"Crossing our fingers big time.
It's a wait-and-see game now," she said.
New destinations for some passengers.
Several passengers decided to change the destination of their holidays.
Melbourne Jetstar passenger Sandra Cannizzaro said she had been given flight points by her airline, and was now heading in a new holiday direction.
"We're looking at Europe, so it's a big change, which has worked in our favour," she said.
Laryssa Johnston said instead of spending 16 days in Bali, her family was now planning to spend 14 days in Hawaii.
"Not much you can do really.
Jetstar has been good, Bali has closed the airport, what do you do?" she said.
Passengers are urged to contact their airlines for up to date advice before heading to the airport.
Authorities closely monitoring volcano.
An alert level for the volcano has not been raised and an exclusion zone around the crater remains at 4 kilometres.
The regional volcanic ash advisory centre in Darwin, Australia, said winds could carry the ash southwest toward Java, Indonesia's most densely populated island.
Meteorologists and pilots will spend today assessing weather conditions and the ash cloud to determine whether the airport will be able to re-open tomorrow morning.
It is just the latest in a series of eruption events which have left thousands of Australian holidaymakers in limbo on the island.
In November, 150,000 local people were evacuated from the mountain and surrounds as volcanic activity intensified.
The local economy is largely dependent on tourism and has been hit hard by the series of eruptions.
Most travel insurance policies for Bali have excluded any volcano-related incidents since it began erupting last year, as it is considered a known risk.
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New WhatsApp status video 2018 | funzoa video WhatsApp status | multimedia channel | - Duration: 0:54.
For more infomation >> New WhatsApp status video 2018 | funzoa video WhatsApp status | multimedia channel | - Duration: 0:54. -------------------------------------------
repair Motherboard Cmos battery section practically class | Bangla - Duration: 15:33.
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GA PERLU KE WARNET LAGI DEH!! DRAGON NEST!! - Duration: 9:49.
Hello youtube hosts welcome to the Liueix channel again
Now we will play the dragon nest game
Once this game can only play on pc, and now this game can play on the phone
Who want to download can click the link in the description
Before the game can subscribe, like commend and share to your friends yes
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Is CABG Heart Surgery on Beating Heart the Best? ("off-pump CABG") (4) - Duration: 3:27.
- In coronary artery bypass surgery, you have performed tens of thousands of procedures,
and you have a particular interest in off-pump coronary artery bypass graft surgery, which
is a surgery on a beating heart. Dr. Anton Titov MD
It's more demanding from the surgeon, technically, but at the same time, it has certain advantages
for patients.
Please compare risks and benefits of off-pump coronary artery bypass graft surgery and on-pump,
the classical technique, and tell us about your experience with this advanced technique
of coronary artery bypass grafting.
- Well, the off-pump surgery was introduced in the 1990s in South America and came to
developed countries in North America and Europe with the so-called MIDCAB operation, which
is a small incision on the lateral chest to do a revascularization of the left anterior
descending artery.
And from this procedure, the so-called OPCAB procedure, off-pump coronary artery beating
heart procedure, was developed where you can graft all three vessels on the beating heart.
The advantage is that you don't need - as "off-pump" name says, you don't need the heart-lung
machine.
For using the heart-lung machine, you have to cannulate the aorta.
This may lead to a dislodgement of debris of aortic plaque, which may lead to embolism,
which may, this may lead to a cerebral infraction.
So, in the SYNTAX study where coronary artery patients were analyzed, the stroke rate was
2.2%.
But if you're using the off-pump technique with the so-called T-graft, where you implant
the LIMA to the LAD, and then a second graft into the LIMA with the so-called aortic no-touch
technique, where you don't perform an aortic anastomosis.
You have no, absolutely no cerebral infraction which is generated by the surgery.
It's a huge deal - to decrease the risk of stroke, and we'll talk about that in a second,
it is a very big deal!
- Yes!
The other thing, which I'm doing to generate this goal is I'm always resecting the left
atrium, because 90% of embolism from the left heart comes from the left atrium.
Because in atrial fibrillation, we have a thrombus formation.
When the patient gets back into the sinus rhythm, the thrombus is ejected and you have
embolism [stroke] And when you resect the left atrium, you're eliminating this risk
as well.
So, this is another point.
No aortic touch, resection of the left atrium, and then you have two major risk factors eliminated,
which may lead to cerebral strokes and other neurological complications.
So, the off-pump procedure has many advantages not only related to a neurologic outcome.
It can be done in patients with major deficiencies, with, for example, with renal disease, with
pulmonary disease.
The avoidance of the heart-lung machine leads to a substantial advantage, and this has been
proven by literature.
And, of course, you need an experienced surgeon, and the surgical technique has to be adequate.
But we have several tools nowadays.
We are measuring the graft flow, the patency and the flow, and you can exactly say this
graft is patent.
The literature says 10 to 15% of the coronary artery anastomosis have technical defects,
and you can detect those immediately, not later in the intensive care via ECG or enzymes.
So, this is a big step towards patient safety.
Then, of course, an OPCAB surgery always maintains the blood pressure.
You have the running ECG.
You have the contracting heart.
These are also parameters to tell you that you're on the safe side, that your anastomosis
is technically adequate, and the patient is going to do well in the long run.
- So, you have a feedback from the patient's body, from the heart, during that duration,
which is also a significant advantage.
- That's exactly the point.
And the patients, they wake up in the same condition after appendectomy, you know.
After heart-lung machine, if patients are sent into a CT scan and doctors see a cerebral
edema which lasts for some period of time.
You have mental deficiencies caused by the heart-lung machine.
All these detrimental factors, you don't have with OPCAB surgery, so it's a big step ahead.
Off-pump CABG has major advantages for severely ill patients, for patients with neurological
deficits.
Those are the advantages where they profit very much from OPCAB surgery.
- But the key factor, of course, is surgeon as the most important prognostic factor for
the patient,
- And then, the patient-related risk factors, of course.
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